68-1010 - Laserfiche WebLink

Home Browse Search

,FOR OFFICE USE: I �r APPLICATION FOR SANITATION PERMIT Permit No: 6.e__.. 1 (Complete in Triplicate) I € - This Permit Expires 1 Year From Date Issued Date Issued i Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application'is made in compliance with County Ordinance No. 549 and xisfiing Rules and Regulations: E JOB ADDRESS/LOC ---- ---C fit/ CENSUS TRACT Owner's Name Phone-' f 7 � Address �.-------- r -- - -- - City 4'`�--------------------------------------------•------ Contractor's Namai _ License # Phone ------------------------------ Installation will serve: Residence Apartmen1t House❑ Commercial ❑Trailer Court l❑ Motel ❑ Other)--------- ---------------------------------- Number of living units:--._ Number of bedrooms _-------Garba_ge Grinder - Lot Size _.9 #,QHS_____________ ____. --------------•--------- n m ------- ---------------Private Water Supply: Public System and name -- ---------------- ------------------------------------- Character of soil to a depth of 3 feet: Sand'❑ Silt❑ ` Clay ❑ „Peat E]- Sandy Loa ❑ Clay Loam ❑ Hardpan ❑ Adobe 9' Fill Material ------------ If yes,type ---------------------- Y (Plot plan, showing size hof lot, location of system in relation t wells, buildings, etc. must'be placed on reverse side.} NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is ayallable within 200 feet,) PACKAGE TREATMENT { SEPTIC TANOC Z Size_ _� __ �_ _ .'3-ry_-- Liquid Depth .-: -t!--....-_ � Capacity tZVV_..-- Type 41--Z, Material .+.�i.__--- No. Compartments ------ �..._. }� Distance to-nearest: Well _r�"l9-0____-----------------Foundation ---1-40-'q Prop. Line ---------�-,...... LEACHING LINE No of Lines ......�---------------- Length f each e._.-�p f-----_----_ Total Length --- LEACHING - --------- a 'Di' Box ____,_______ Type Filter Material -4-Depth Filter Material . .__ , -------- -- ------ •------ IM " ----- Foundation .. ` " Property Line. ......---= t Distance to nearest: Well nn �- __ Rock Filled 'Yes No : i SEEPAGE PIT, �. Depth _.C�_�_----;_ Diameter --- --______ Number _ _____________ �] W'�ter Table Depth d �------------- ---------->--------Rock Size �'��.��yL �f-------- l �a . r �1 C� Distance to nearest: WeIIII- -- -----------------•-..Foundation / a------- Prop Line �_.........� I Fi REPA10'/X DITION(Prev. Sanitation Permit# ----------------------------------- bate --------------------------- Septic,Tank;(Specify FRecMuirements) ......... - - -----------------------------------------`-------------------- ,,.------------- --------.._.. Disposal -Field (Specify, _--== Requirements) --------------•--------------------------------------------------------------------------------------------- ------------ N J Y -. -_--_---__--_______________________ -----------------------------------------------------—-------.___---.— a----- .----_----__-------_-_.____________--_.________.___.___________.__.____..____.______-__ _________________________ --- -.---_---_---_ ---_-.-_--------_----__- _____ .. _____-__-_--.---------.- _-_.-_ ----.---____--____-_.--_--------__-______-_-_--_---_._-__ .w fe (Draw existing and required addition on reverse side) t, I hereby certify thatpl ha� prepared[th'is-application and that the work wilt be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of-the.,San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any'person in such manner as to Zb ub}ect t Workman's Compens n laws of California."�s Co14 Sign --- -- `�- - �\,(-ta �3 r L--t---- /fir -------------- Owner BY ---------- ------- Title --------------- --------------- --- ------------------------------------ tl 7— (If other tea owner) _ -- ti 3 4 1E FOR DEPARTMENT USE ONLY -- APPLICATION ACCEPTED-B " ---- -- - ------- - - - - - !��-- - -- DATE -----2--- ------ �-------------=------- ( BUILDING PERMIT 1SSU :I ------------------------------ �----tT-Z.- -----------------•--------------DATE ------------------------------------------- ADDITIONAL --------- -------------------------=----- i ------------------ - -- - - E ADDITIONAL COMMEN it ___ _________ ---------- -------------------- - .-- _ _ r 'M P ------ _ ------------------------- - -------------------- ------- -- ------------------ -_.i Final Inspection by: _-. �5_�Ji( uT-' -----------------------------•------------------------ --- --- -- .Date __....1j-------- A. --------------*_ / - -- v SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6B Rev. 5M.,